Lower Limb Injury Prevention Research Articles

Functional knee stability in elite field hockey depends on playing class and gender

Field hockey, a physically demanding Olympic sport, carries a high risk of lower limb injuries, yet data on injury risk in elite field hockey are limited. Functional knee stability is important for injury prevention and a safe return to sport. This study is the first to investigate functional knee stability in elite field hockey, considering gender and playing class, and establishes reference data for functional knee stability by using a standardized test battery that assesses one- and two-legged stability, jumping tests, speed, and agility. 72 elite field hockey players, 30 males and 42 females (age 19.82 ± 3.74 years) were divided into High Playing Class (HPC) and Moderate Playing Class (MPC). HPC players showed significant better performance in all functional tests except balance tests (p <0.01-0.024). Females showed significantly better one- and two-leg stability (p <0.01) with lower injury rates, indicating the relevance of gender considerations. The study emphasizes the importance of balance and stability in the prevention of lower limb injuries in Olympic field hockey and also highlights the importance of considering pre-existing deficits in functional knee capability when assessing athletes for return to sport. These results can help improve athletic performance, identify individual strengths and weaknesses, prevent injury or re-injury, and facilitate return to sport after injury.

Neuromuscular Training Effects on Athletes’ Jumping and Lower Limb Injury: A Systematic Review

This study assessed the impact of integrated neuromuscular training (INT) on athletes’ jumping performance and lower limb injury prevention. A thorough search across multiple databases, including PubMed, Web of Science, Science Direct, and the Cochrane Library, identified a sample of 19,805 athletes aged between 8.5 and 27.7 years. Results showed that INT led to a significant improvement in jumping ability (SMD = 0.45, 95% CI 0.30–0.60, P = 0.000) and a reduction in lower limb injuries (SMD = 0.68, 95% CI 0.62–0.74, P = 0.000). The most effective interventions lasted at least 25 minutes, conducted 2-5 times per week, for a minimum of 9 weeks. This approach was particularly beneficial for children and adolescents, as it enhanced their countermovement jump (CMJ) ability and helped in the prevention of injuries.

A Literature Review on Neuromuscular Control Training in Chronic Ankle Instability for the Prevention of Lower Limb Injuries

A Literature Review on Neuromuscular Control Training in Chronic Ankle Instability for the Prevention of Lower Limb Injuries

The Effect of the FIFA 11+ Kids Warm-Up Training Program on Lower Limb Injury Prevention and Football Player Performance (A Systematic Review)

The Effect of the FIFA 11+ Kids Warm-Up Training Program on Lower Limb Injury Prevention and Football Player Performance (A Systematic Review)

Effects of Different Hamstring Eccentric Exercise Programs on Preventing Lower Extremity Injuries: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis aims to investigate the effects and differences of various hamstring eccentric training protocols for the prevention of lower limb injuries, and we further propose a more refined hamstring eccentric training protocol for the prevention of lower limb injuries. A literature search for the effects of hamstring eccentric training on lower extremity sports injuries was conducted using the PubMed, Web of Science, and EMBASE databases, and the literature was searched covering the period from the date of the database's creation to 20 August 2022. A meta-analysis of the included literature was performed using R.4.21 for lower extremity injuries, injuries in various parts of the lower extremity, and subgroup analysis for exercise frequency, exercise cycle, and exercise population. A total of 23 randomized controlled trial (RCT) studies were found to be included in the meta-analysis, and 15 of these trials, totaling 14,721 patients, were determined to be included in the overall lower extremity injury prevention effect. The analysis showed that the implementation of a hamstring eccentric training program reduced lower extremity injuries by 28%, and it resulted in a 46% decrease in hamstring injury rate and a 34% decrease in knee injury rate. The subgroup analysis revealed that the frequency of exercise was most significant in the twice-a-week exercise group, that the exercise program was most effective in preventing injuries in the 21-30-week exercise period, and that the program was most effective in preventing injuries in elite athletes and amateur adult athletic populations, compared with adolescents.

Training habits and lower limb injury prevention in parkour practitioners

Parkour consists of overcoming obstacles mostly in an urban landscape. Little is known regarding usual training habits and injury risks of traceurs, i.e., parkour practitioners. In this study, a 20-min survey have been fulfilled by a population of traceurs regarding training load, habits (type of warm up, physical conditioning, stretching), type of footwear, and number and type of ankle- and knee-injuries during their career. A total of 180 responses were analyzed (24.4 ± 5.9 years old, 21.7% female, 6.0 ± 3.9 years of experience). Participants reported to train 1 to 7 times per week for a mean duration of 2.2 h. 76% practiced stretching exercises. 75.6% practiced physical conditioning in addition to their parkour training (weightlifting, functional exercises). Injury rate was 1.7 per 1000 h of training, mostly ankle sprains and knee contusions. Number of injury and training load were positively correlated. The lack of physical conditioning was also a factor of injury. Knee injuries have been more frequent on participants wearing minimalist shoes. Although training appears well auto-organized and the injury rate quite low some pitfalls require attention, notably in training planning, warm-up, stretching and conditioning. Building training and coaching methods specific to parkour appears essential.

The Effects of a 10-Week Neuromuscular Training on Postural Control in Elite Youth Competitive Ballroom Dancers: A Randomized Controlled Trial.

The purpose of this randomized controlled trial was to evaluate the efficacy of a 10-week neuromuscular training (NMT) program on the postural control of elite youth competitive ballroom dancers. Forty-two dancers (21 couples) were randomly assigned to either the NMT group (n = 22) or the control group (CG; n = 20). Participants in NMT underwent a three-sessions-per-week NMT program for 10 weeks. Testing at baseline and after the 10 weeks intervention included the Y-balance test (YBT) and Modified-Balance Error Scoring System (M-BESS). Results of YBT indicated that NMT participants demonstrated increased reach in the posterolateral and posteromedial directions for the right and left lower limb, whereas no significant change was found in the anterior direction for both limbs. Results of Modified-Balance Error Scoring System (M-BESS) showed that NMT participants displayed significantly decreased errors of the double-leg floor (p = 0.026), single-leg foam (p = 0.010), double-leg foam (p = 0.003), tandem floor (p = 0.031), and tandem foam (p = 0.038), while no significant change was found in single-leg floor performance (p = 0.476). CG participants did not exhibit any significant change during the 10-week period. In summary, the study affirmed that the 10-week NMT program enhanced the postural control performance of youth ballroom dancers and showed effects on ballroom dance-specific performance and lower-limb injury prevention. The results suggest that NMT may be a valuable addition to ballroom dance training regimens.

Muscle Activation Differences During Eccentric Hamstring Exercises.

The hamstring muscles play a critical role in the prevention of lower limb injuries. However, it is still unclear which exercises are more effective in terms of muscle activation. In healthy individuals, there are differences between muscular activations of the biceps femoris (BF), semitendinosus (ST), and semimembranosus (SM) muscles during eccentric hamstring exercises. Cross-sectional. Level 2. A total of 31 healthy participants (18 male; mean age, 22.5 years; SD, 3.1) were included in this study. The maximum voluntary isometric contraction of the hamstring muscles was measured using an isokinetic dynamometer. The participants were asked to perform one of the following exercises randomly (3 repetitions each): stiff-leg deadlift (SLDL), unilateral stiff-leg deadlift (USLDL), Nordic hamstring exercise (NHE), and ball leg curl (BLC). Activation of the BF, ST, and SM muscles was measured using surface electromyography during the exercises. In the statistical analysis of this study, factorial analysis of variance was used to compare the effects of each exercise on the muscle groups and to analyze which exercise type was more effective for each muscle group. The NHE led to higher muscle activation than the other exercises (P < 0.001). When exercise type and muscle interaction were examined, SM activation was lower than BF (P = 0.04) and ST (P = 0.001) during NHE (P < 0.05). The highest level of muscular activation was recorded during the NHE in both male and female participants. The NHE may be the most effective exercise for the hamstring muscles as it leads to greater muscle activation. SLDL, USLDL, and BLC exercises may be preferred at the beginning of strength training programs since they lead to lower muscular activation compared with the NHE. To select the optimum hamstring exercise, it is important to know the activation levels of the hamstring muscles during different eccentric exercises.

Foot Muscle Strengthening and Lower Limb Injury Prevention

ABSTRACT Background and objectives: The active and passive structures of the foot act in unison to not only be compliant enough to assist in ground reaction force attenuation but also resist deformation to provide a stable base of support. A foot that is unable to adjust to the imposed demands during high-intensity sporting activities may alter the moments and forces acting on the joints, increasing the risk of non-contact anterior cruciate ligament ruptures (ACLR) and lateral ankle sprains (LAS). Prophylactic strengthening programs are often used to reduce the risk of these injuries, but at present, very few prophylactic programs include foot-specific strengthening strategies. The aim of this theoretical review is to ascertain the prophylactic role strengthening muscles acting on the foot may have on ACLR and LAS injury risk. Methods: Literature relating to risk factors associated with ACLR and LAS injury and the anatomy and biomechanics of normal foot function was searched. In addition, ACLR and LAS injury prevention programs were also sought. A theoretical, narrative approach was followed to synthesize the information gathered from the articles. Results: The foot segments are governed by the congruity of the articulations and the activity of the foot muscles. As such, there is a coupling effect between shank, calcaneus, midfoot, and hallux movement which play a role in both ACLR and LAS injury risk. Conclusions: Strengthening the muscles acting on the foot may have a significant impact on ACLR and LAS injury risk.

Injuries in badminton: A review

The aim of this review is to provide an overview of the injury risks in badminton, by exploring and takes a global approach related to the eyes, and upper and lower limbs. This explain how the injury occurred and as well as medical and training recommendations for athletic population. Badminton injuries are around 1–5% of all sports injuries. It ranked six after soccer, basketball, volleyball, long-distance running and cycling. Such knowledge could help coaches and fitness trainers focus on the specific muscular activities required to prevent injuries. The relationship between scientists and coaches, particularly in terms of biomechanics and physiotherapy, will help improve performance and prevent injury. Badminton will be influenced by the evolution of intensity of the game. It is apparent that the movement patterns and movement demands are related to an increase in injuries and the generation of new injuries. Eye injury occurs when shuttlecock impact from an opponent's stroke. Wearing glasses can considerably reduce the risk of eye injury. Injuries to the arm and shoulder are due to faulty technique, while leg and back injuries are caused mainly by a lack of strength or mobility. The contribution of the trunk to the prevention of lower limb injuries suggests that specific attention should be paid to this area. Fatigue influences the way that lunges are performed, and the jump is received by making these tendons less powerful and more unstable. Training program increases body strength to prevent injuries. L’objectif de cette revue est de fournir un aperçu sur les risques de blessures en badminton en explorant et en adoptant une approche globale des blessures des yeux, des membres supérieurs et inférieurs. Cela explique comment la blessure a eu lieu et de ce fait, propose des recommandations médicales et d’entraînement pour les sportifs. Les blessures en badminton sont autour de 1–5 % des blessures sportives. Elles sont classées sixième après celles du football, du basketball, du volleyball, de la course à pied et du vélo. Les connaissances pourraient aider les entraîneurs et les préparateurs physiques à se focaliser sur les activités musculaires spécifiques dans la prévention des blessures. La relation entre les scientifiques et les entraîneurs, notamment en biomécanique et en physiothérapie contribuera à améliorer les performances et prévenir les blessures. Le badminton sera influencé par l’évolution de l’intensité des échanges. Il est visible que les modèles et les exigences des mouvements vont augmenter le nombre de blessures et d’en générer de nouvelles. Une blessure oculaire survient suite à un coup de volant frappé par l’adversaire. Le port de lunette peut réduire considérablement le risque de blessure aux yeux. Les blessures au bras et à l’épaule sont dues à une mauvaise technique, tandis que les blessures aux jambes et au dos sont principalement causées par un manque de force ou de mobilité. La contribution du tronc dans la prévention des blessures des membres inférieurs suggère une attention toute particulière à cette zone. La fatigue influence la production des fentes et la réception des sauts rend les tendons moins puissants et plus instables. Les programmes ciblés d’entraînements augmentent la force du corps afin de prévenir les blessures.

The Electromyographic Feedback and Feedforward Activity of Selected Lower Extremity Muscles During Toe-in Landing in Female Athletes

PurposePositioning the legs in performing spike technique significantly contributes to the development and prevention of lower limb injuries. The present study aimed to evaluate and compare the feedback and feedforward activaties of selected lower limb muscles during triple jump spike with and without toe-in landing in female volleyball players.MethodsIn this controlled-laboratory study, 15 female elite volleyball players performed triple spike in toe-in and neutral positions. The electrical activity of tibialis anterior, proneus longus, gastrocenemius, vastus medialis, vastus lateralis, semitendinosus, and biceps femoris muscles was recorded using a 16-channel surface electromyography device (Baya Med Company). The Dependent Samples t-test was applied to analyze the obtained data at the 95% confidence level.ResultsIn toe-in landing, the semitendinosus muscle activity (P=0.040) significantly decreased in the feedforward phase. Besides, in the feedback phase, there were significant increases in tibialis anterior (P=0.039) and proneus longus (P=0.043). Eventually, a significant decrease was observed in the medial gastrocenemius (P=0.042) and biceps femoris muscle (P=0.047) activities.ConclusionDecreased biceps femoris muscle activity during the feedback phase with the toe-in position may be associated with the decreased supportive effect of hamstring muscle, increased anterior knee shear force, and subsequently anterior cruciate ligament injury. Increased activity of leg and ankle muscles may also increase the odds of muscular fatigue and subsequent ankle sprain during toe-in landing.

Lower limb injury prevention programs in youth soccer: a survey of coach knowledge, usage, and barriers

BackgroundParticipation in youth soccer carries a significant risk of injury, most commonly non-contact injuries of the lower extremity. A growing body of research supports the use of neuromuscular interventions by teams to prevent such injuries, yet the uptake of these recommendations by soccer teams remains largely unexplored. The purposes of the study were to determine (1) the level of awareness by youth coaches of injury prevention programs and their efficacy; (2) the number of youth coaches that use these interventions; and (3) barriers and potential facilitators to implementing a sustainable injury prevention program.MethodsFour hundred eighteen coaches of male and female youth soccer teams were emailed an online blinded survey. This survey consisted of 26 questions covering coaches’ demographics, level of training, experience with injuries among players, and use of injury prevention programs. Question development was guided by the RE-AIM Sports Setting Matrix in combination with findings from the literature review and expert experience from orthopaedic surgeons specializing in sport medicine.ResultsOf the 418 coaches contacted, 101 responded. Only 29.8% of respondents used an injury prevention program in the prior soccer season. Coaches that had completed one or more coaching courses were more likely to use an intervention. Of those that did not already use an intervention, coaches agreed or strongly agreed that they would consider using one if it could be used in place of the warm up and take no more than 20 min (74.0%), if they could access information about the exercises (84.0%), and if the exercises could be properly demonstrated (84.0%). Additionally, 84% of coaches that did not already use an intervention agreed or strongly agreed that knowing that interventions may reduce a player’s risk of injury by 45% would affect whether they would use one.ConclusionThis study suggests that the current use and awareness of injury prevention programs is limited by a lack of communication and education between sporting associations and coaches, as well as perceived time constraints. The results also suggest that improving coaching education of injury prevention could increase the frequency of intervention use.

Evaluation of the implementation of a lower limb injury prevention program in community Australian football

Evaluation of the implementation of a lower limb injury prevention program in community Australian football

Foot core strengthening: relevance in injury prevention and rehabilitation for runners

The human foot is a flexible structure characterized by a pronounced medial longitudinal arch (MLA) that compresses and recoils during running. That process is actively driven by the intrinsic foot muscles and requires a proper stability of the MLA. This introduces the concept of foot core stability. Because the intrinsic foot muscles are often neglected by clinicians and researchers, the purpose of this article is to provide some guidelines for incorporating foot core training in prevention or rehabilitation programmes for runners. The intrinsic foot muscles play a key role in postural control and maintain balance during single leg stance by controlling the height of the MLA and the foot pronation. During running, these muscles lengthen eccentrically during the absorption phase and subsequently shorten as the arch recoils during the propulsive phase, functioning in parallel to the plantar fascia. As a consequence, the dysfunction or weakness of the MLA active support may lead to injuries (e.g. plantar fasciopathy, Achilles or Tibialis posterior tendinopathy, metatarsalgia or medial tibial stress syndrome), due to numerous biomechanical cascades and mechanisms. In order to counteract or prevent these impairments, there are two ways for enhancing the foot core stability. Firstly in terms of volitional control of the intrinsic foot muscles, the “short foot exercise” must be practiced. Secondly strengthening sessions using neuromuscular electrical stimulation of these muscles seem to be a promising strategy in order to support the MLA and control the pronation during running. Practically, the foot core strengthening protocol may beneficiate not only the runners affected by excessive pronation related injuries but also those who sustained a long term lower limb injury and may be affected by a detraining process. In addition we warmly recommend integrating this protocol in any lower limb injury prevention programme or strength and conditioning plan for runners.

Relationships Between Toe-Grip Strength and Static and Dynamic Balance During Single-leg Stance

Postural control deficit is considered a factor for lower limb injuries in athletes, such as knee and ankle joint injuries, and in recent years, relationships have been suggested between toe-grip strength and static and dynamic balance. Female athletes have a higher incidence of knee and ankle joint injuries than males, especially in soccer, basketball, and lacrosse. PURPOSE: The purpose of this study was to examine the relationships between toe-grip strength and static and dynamic balance during single-leg stance in female collegiate lacrosse players. METHODS: Thirty-three female collegiate lacrosse players (mean age 19.3 ± 0.9 years, mean height 159.2 ± 5.4 cm, mean weight 55.3 ± 5.1 kg) participated in this study. Static balance was tested using a stabilometer by having participants maintain a single-leg stance for 30 s, with outcome measures including total locus length, total locus length per unit area and per unit time, and circumference and rectangular area of body sway. Dynamic balance was evaluated using three directions on the star excursion balance test (anterior, posteromedial, and posterolateral). Correlations between toe-grip strength and static and dynamic balance were determined using Pearson’s correlation coefficient. The unpaired t-test was used to compare athletes with greater and lesser toe-grip strength. Significance level was p < 0.05. RESULTS: Toe-grip strength of the right foot was significantly negatively correlated with total locus length and total locus length per unit time (r = −0.354, p = 0.043, respectively), and athletes with a strong right-foot toe-grip had significantly shorter total locus length and total locus length per unit time compared with those with a weak one (p = 0.043, respectively). Athletes with a strong left-foot toe-grip had significantly longer normalized anterior reach distance (reach distance divided by leg length and multiplied by 100) on the star excursion balance test compared to those with a weak one (p = 0.020). CONCLUSIONS: This study suggests that toe-grip strength in female collegiate lacrosse players is related to static and dynamic balance ability in the single-leg stance and that its measurement and evaluation may contribute to the prevention of lower limb injuries, such as knee and ankle joint injuries, among female athletes.

Could Targeted Exercise Programmes Prevent Lower Limb Injury in Community Australian Football?

Australian football is a popular sport in Australia, at both the community and elite levels. It is a high-speed contact sport with a higher incidence of medically treated injuries when compared with most other organized sports. Hamstring injuries, ligament injuries to the knee or ankle, hip/groin injuries and tendinopathies are particularly common and often result in considerable time lost from sport. Consequently, the prevention of lower limb injuries is a priority for both community and elite Australian football organizations. There is considerable literature available on exercise programmes aimed at reducing lower limb injuries in Australian football and other running-related sports. The quality and outcomes of these studies have varied considerably, but indicate that exercise protocols may be an effective means of preventing lower limb injuries. Despite this, there has been limited high-quality and systematic evaluation of these data. The aim of this literature review is to systematically evaluate the evidence about the benefits of lower limb injury prevention exercise protocols aimed at reducing the most common severe lower limb injuries in Australian football. The Cochrane Central Register of Controlled Trials, the Cochrane Bone Joint and Muscle Trauma Group Specialized Register, MEDLINE and other electronic databases were searched, from January 1990 to December 2010. Papers reporting the results of randomized controlled trials (RCTs), quasi-RCTs, cohort and case-control studies were extracted. Primary outcomes were injury reduction or risk factor identification and/or modification. Secondary outcomes were adherence to any trialled interventions, injury severity and adverse effects such as secondary injuries and muscle soreness. The methodological quality of extracted manuscripts was assessed and results were collated. Forty-seven papers were identified and reviewed of which 18 related to hamstring injury, eight related to knee or ankle ligament injury, five related to tendon injury and four were hip or groin injury related. Another 12 papers targeted general lower limb injuries. Most (n = 27 [57%]) were observational studies, investigating injury risk factors. Twenty reported the results of intervention trials. Of these, 15 were efficacy trials reporting the effects of an intervention in reducing injury rates, four were biomechanical interventions in which the impact of the intervention on a known injury risk factor was assessed and one reported changes in injury risk factors as well as injury rates. The strength of the evidence base for exercise programmes for lower limb injury prevention was found to be limited, primarily due to the research methods employed, low adherence to interventions by the study participants and a lack of statistical power. Limited evidence obtained from a small number of RCTs suggests that balance and control exercises might be efficacious in preventing ankle ligament injuries and a programme involving a combination of balance and control exercises, eccentric hamstring, plyometrics and strength exercises could be efficacious in preventing all lower limb injuries. Overall, the evidence for exercise programmes as an efficacious lower limb injury prevention strategy is predominantly restricted to studies addressing injury aetiology and mechanisms. The findings of this review highlight the need to develop and test interventions in well designed population-based trials with an emphasis on promoting intervention uptake and adherence and, hence, intervention effectiveness. The results of this review can inform the development of the components of a future lower limb injury prevention exercise protocol for community-level Australian football.

Information technologies: opportunities and challenges in personal healthcare systems

The well-being of a person consists of two aspects, the physical and the psychological. Technological development makes it possible to mass-produce cheap sensors for personal use. The data collected provide objective and comprehensive personal health information. In this paper, we report our preliminary findings in applying modern information technology to personal healthcare systems. We are constructing a brain activity level model by using EEG signals to objectively measure the effectiveness of meditation, detect mental fatigue and boredom, and comprehend human emotions. Also we have used accelerometer and GPS data to assess sports performance and training enhancement, lower limb injury prevention and recovery monitoring, and falls prevention for aged people. Then we exploit the potential of Kinect devices in monitoring the movements of aged persons in their houses to prevent falls. Finally, we point out some remaining challenges and possible opportunities in using information technologies to deliver personal healthcare.

Retraction Note: a descriptive study of a manual therapy intervention within a randomised controlled trial for hamstring and lower limb injury prevention

The journal has been informed by its publisher BioMed Central that contrary to the statement in this article [Wayne Hoskins, Henry Pollard, Chiropractic & Osteopathy 2010, 18:23], they have been advised by the authors' institution Macquarie University, that its Human Research Ethics Committee did not approve this study. Because the study was conducted without institutional ethics committee approval it has been retracted.

A descriptive study of a manual therapy intervention within a randomised controlled trial for hamstring and lower limb injury prevention

BackgroundThere is little literature describing the use of manual therapy performed on athletes. It was our purpose to document the usage of a sports chiropractic manual therapy intervention within a RCT by identifying the type, amount, frequency, location and reason for treatment provided. This information is useful for the uptake of the intervention into clinical settings and to allow clinicians to better understand a role that sports chiropractors offer.MethodsAll treatment rendered to 29 semi-elite Australian Rules footballers in the sports chiropractic intervention group of an 8 month RCT investigating hamstring and lower-limb injury prevention was recorded. Treatment was pragmatically and individually determined and could consist of high-velocity, low-amplitude (HVLA) manipulation, mobilization and/or supporting soft tissue therapies. Descriptive statistics recorded the treatment rendered for symptomatic or asymptomatic benefit, delivered to joint or soft tissue structures and categorized into body regions. For the joint therapy, it was recorded whether treatment consisted of HVLA manipulation, HVLA manipulation and mobilization, or mobilization only. Breakdown of the HVLA technique was performed.ResultsA total of 487 treatments were provided (mean 16.8 consultations/player) with 64% of treatment for asymptomatic benefit (73% joint therapies, 57% soft tissue therapies). Treatment was delivered to approximately 4 soft tissue and 4 joint regions each consultation. The most common asymptomatic regions treated with joint therapies were thoracic (22%), knee (20%), hip (19%), sacroiliac joint (13%) and lumbar (11%). For soft tissue therapies it was gluteal (22%), hip flexor (14%), knee (12%) and lumbar (11%). The most common symptomatic regions treated with joint therapies were lumbar (25%), thoracic (15%) and hip (14%). For soft tissue therapies it was gluteal (22%), lumbar (15%) and posterior thigh (8%). Of the joint therapy, 56% was HVLA manipulation only, 36% high-HVLA and mobilization and 9% mobilization only. Of the HVLA manipulation, 63% was manually performed and 37% mechanically assisted.ConclusionsThe intervention applied was multimodal and multi-regional. Most treatment was for asymptomatic benefit, particularly for joint based therapies, which consisted largely of HVLA manipulation techniques. Most treatment was applied to non-local hamstring structures, in particular the knee, hip, pelvis and spine.

The effect of a sports chiropractic manual therapy intervention on the prevention of back pain, hamstring and lower limb injuries in semi-elite Australian Rules footballers: a randomized controlled trial

BackgroundHamstring injuries are the most common injury in Australian Rules football. It was the aims to investigate whether a sports chiropractic manual therapy intervention protocol provided in addition to the current best practice management could prevent the occurrence of and weeks missed due to hamstring and other lower-limb injuries at the semi-elite level of Australian football.MethodsSixty male subjects were assessed for eligibility with 59 meeting entry requirements and randomly allocated to an intervention (n = 29) or control group (n = 30), being matched for age and hamstring injury history. Twenty-eight intervention and 29 control group participants completed the trial. Both groups received the current best practice medical and sports science management, which acted as the control. Additionally, the intervention group received a sports chiropractic intervention. Treatment for the intervention group was individually determined and could involve manipulation/mobilization and/or soft tissue therapies to the spine and extremity. Minimum scheduling was: 1 treatment per week for 6 weeks, 1 treatment per fortnight for 3 months, 1 treatment per month for the remainder of the season (3 months). The main outcome measure was an injury surveillance with a missed match injury definition.ResultsAfter 24 matches there was no statistical significant difference between the groups for the incidence of hamstring injury (OR:0.116, 95% CI:0.013-1.019, p = 0.051) and primary non-contact knee injury (OR:0.116, 95% CI:0.013-1.019, p = 0.051). The difference for primary lower-limb muscle strains was significant (OR:0.097, 95%CI:0.011-0.839, p = 0.025). There was no significant difference for weeks missed due to hamstring injury (4 v14, χ2:1.12, p = 0.29) and lower-limb muscle strains (4 v 21, χ2:2.66, p = 0.10). A significant difference in weeks missed due to non-contact knee injury was noted (1 v 24, χ2:6.70, p = 0.01).ConclusionsThis study demonstrated a trend towards lower limb injury prevention with a significant reduction in primary lower limb muscle strains and weeks missed due to non-contact knee injuries through the addition of a sports chiropractic intervention to the current best practice management.Trial registrationThe study was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12608000533392).